Debit Authorization

        I (we) hereby authorize St. Mary’s Church, hereinafter called COMPANY, to initiate debit entries to my (our) account indicated below and the financial institution named below, hereinafter called FINANCIAL INSTITUTION, to debit the same to such account for _________________________________.

      I (we) acknowledge that the origination of ACH transaction to my (our) account must comply with the provisions of US law.

__________________________________________________________              _________________________________________________
    (Financial InstitutionName)                                                                      (Branch)  

___________________________________________________________________________________________________________________
     (Address)                                                                                     (City/State)                                                      (Zip)

__________________________          ___________________________        Type of Account:  Checking _______Savings________
   (Routing Number)                          (Account Number)

Amount of Debit: ___________________                 Effective Date: ___________________           Frequency: _________________

      This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and manner as to afford COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it.

_______________________________________________________               ____________________________________________________
    (Print Individual Name)                                                                            (Signature)     

_____________________________
    (Date)

_____
(Dat
            PLEASE ATTACH COPY OF VOIDED CHECK TO THIS FORM.